Unsuccessful Xpert® MTB/RIF results: the Nigerian experience.

Setting: Nigeria, a high tuberculosis (TB) burden country. Objective: To study the rate, distribution and causes of unsuccessful Xpert® MTB/RIF test outcomes, with the aim of identifying key areas that need to be strengthened for optimal performance of the assay. Design: This was a retrospective analysis of data uploaded between January and December 2015 from Xpert facilities to the central server using GXAlert. Result: Of 52 219 test results uploaded from 176 Xpert machines, 22.5% were positive for Mycobacterium tuberculosis, 10.8% of which were rifampicin-resistant; 4.7% of the total number of results were invalid, 4.2% had error results and 2.1% no result outcomes. Technical errors were most frequent (69%); these were non-seasonal and occurred in all geopolitical regions and at all health facility levels. Temperature-related errors were more prevalent in the North-West Region, with peaks in April to June. Peak periods for temperature and machine malfunction errors coincided with the periods of low utilisation of the assay. Conclusion: The key challenge affecting performance was poor adherence to standard operating procedures. Periodic refresher training courses, regular supervision, preventive maintenance of Xpert machines and proper storage of cartridges are strategies that could improve Xpert performance.

Contexte : Le Nigeria, pays lourdement frappé par la tuberculose.Objectif : Etudier le taux, la distribution et les causes de mauvais résultats du test Xpert dans le but d'identifier les domaines clés qui doivent être renforcés pour une performance optimale du test.Schéma : Analyse rétrospective des données téléchargées entre janvier et décembre 2015 depuis les structures équipées de Xpert vers le serveur central à travers le GXAlert.Résultats : Sur 52 219 tests téléchargés à partir de 176 machines, 22,5% ont été positifs pour Mycobacterium tuberculosis, dont 10,8% ont été résistants à la rifampicine ; globalement, 4,7% ont été invalides, 4,2% ont eu des résultats erronés et 2,1% n'ont eu aucun résultat. Les erreurs d'origine technique ont été les plus fréquentes, à 69%, n'ont pas eu de variation saisonnière et sont survenues dans toutes les zones géopolitiques et à tous les niveaux des structures de santé. Les erreurs liées à la température ont été prévalentes dans la région nord-ouest, avec des pics d'avril à juin. Les périodes de pic en termes de température et de dysfonction des machines ont coïncidé avec les périodes de faible utilisation du test.Conclusion : Le problème principal qui a affecté la performance du test a été l'adhérence médiocre aux procédures opératoires standardisées. Des révisions périodiques de la formation, une supervision régulière, une maintenance préventive de la machine à Xpert et un stockage approprié des cartouches constituent des stratégies susceptibles d'améliorer la performance du Xpert.

Marco de referencia: Nigeria, un país con alta carga de morbilidad por tuberculosis.Objetivo: Estudiar la tasa de resultados fallidos de la prueba Xpert, su distribución y sus causas con el objeto de reconocer las esferas prioritarias que precisan fortalecimiento, a fin de obtener un funcionamiento óptimo de la prueba.Método: Fue este un análisis retrospectivo de los datos enviados al servidor central por los establecimientos que practican la prueba Xpert, mediante el sistema GXAlert, de enero a diciembre del 2015.Resultados: De 52 219 pruebas realizadas en 176 dispositivos y subidas al sistema, 22,5% fueron positivas para Mycobacterium tuberculosis y de ellas el 10,8% presentó resistencia a rifampicina; de todos los resultados, 4,7% fueron inválidos, 4,2% exhibieron error y 2,1% de las pruebas no comportaban un resultado. El error más frecuente fue el de tipo técnico (69%), el cual no siguió un carácter estacional y ocurrió en todas las regiones geopolíticas y en establecimientos de salud de todos los niveles. Los errores debidos a la temperatura predominaron en la región noroeste, con períodos de mayor frecuencia de abril a junio. Los períodos de mayor frecuencia de errores causados por la temperatura o el disfuncionamiento de los dispositivos coincidieron con épocas de baja utilización de la prueba.Conclusión: El principal problema que interfirió con el buen funcionamiento de la prueba fue el incumplimiento de los procedimientos normalizados de trabajo. Se podría mejorar la eficacia de la prueba Xpert mediante estrategias como los cursos periódicos de actualización, la supervisión constante y el mantenimiento preventivo de los dispositivos, además del almacenamiento adecuado de los cartuchos de la prueba.

Self-reported sleep parameters among secondary school teenagers in middle-belt Nigeria.

BACKGROUND: Available evidences seem to suggest increasing trend in sleep deficit among teenagers worldwide, and there is limited information on this among Nigerian teenagers. This study was carried out to determine the basic sleep schedule and sleep duration among schooling teenagers in Ilorin, Nigeria. METHODS: This is a descriptive cross-sectional study conducted among 20 selected public secondary schools in Ilorin, Nigeria. A multistage sampling technique was used to randomly select participating schools. RESULT: A total of 1033 students participated in the study; of these 47.3% were males and 51.7% females. Students mean age (standard deviation) was 15.3 ± 1.6 years with a range of 12-19 years. Majority (76.2%) of participants co-share bed with at least one person and some (23.8%) slept alone in bed. The three leading reasons given for going to bed were: Tiredness - 31.1%, completion of house assignment - 20.5%, and parental directive - 12.4%. 10% of teenagers do make regular phone calls at night and 5.5% surf internet and use computers at night. Regular habits of daytime sleepiness were reported by 8.2% of study participants. Students' mean sleep duration during school days was 9.33 ± 2.29 h compared to 10.09 ± 1.32 h at weekend (P < 0.05). The duration of night time sleep was adequate (>9 h) in 41% of students; borderline (8-9 h) in 44.3% while 13.3% of the students had insufficient nighttime sleep duration (<8 h) P < 0.05. CONCLUSION: A substantial number of students had borderline nighttime sleep duration and so had potentials to transit into the problematic insufficient range. To prevent this, there is a need to educate schooling teenagers on the dangers associated with prolonged sleep insufficiency.

RISK FACTORS AND SERO-PREVALENCE OF HEPATITIS B SURFACE ANTIGEN AMONG BLOOD DONORS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN, NIGERIA.

BACKGROUND: Availability of safe blood and blood products for transfusion is increasingly difficult globally, especially in developing countries because of high prevalence of Transfusion Transmissible Infections. OBJECTIVES: To determine the prevalence of HBsAg among blood donors and to evaluate the socio-economic, demographic and medical factors associated with its infection. DESIGN: A prospective study. SUBJECTS: Three hundred and fifty consecutive blood donors were recruited. 2 ml of venous blood was collected aseptically from the ante-cubital vein and subjected to serological test for HBsAg. RESULTS: High prevalence rate 10.9% was recorded. All the donors reactive to HBsAg were males (38,100%) with a mean age of 30.7 ± 8.02 years, while 55.3%, 44.7%, 5.3%, 42%, 47.4%, 5.3% of them were single, married, primary school graduate, secondary school graduate, tertiary school graduate and illiterate respectively with 36.8%, 23.7%, 39.5% and 0% been unemployed, civil servants/professionals, skilled artisans and business/petty traders. The most common risk factor was multiple sexual partners 55.3%, followed by extra marital affairs 13.2%, tattooing 10.5%, previous blood transfusion 5.2%, previous surgery 2.6% and sex trading 2.6%. CONCLUSION: Active public enlightenment programmes and strict blood donation selection criteria need to be put in place in order to provide safe blood and blood products for transfusion.

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria.

BACK GROUND: Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors. OBJECTIVE: To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria. METHODS: All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010). RESULTS: Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity. CONCLUSION: Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.

Sero-prevalence of syphilis among patients with mental illness: comparison with blood donors.

BACKGROUND: Mentally ill individuals (MII) are at risk of acquiring syphilis and other sexually transmitted infections. This study aimed at determining sero-prevalence of syphilis among MII and compare them with voluntary blood donors (VBD) at University of Ilorin Teaching Hospital (UITH), Nigeria. METHODS: A cross-sectional study done between June, 2010 and June 2011, and involving 350 each of VBDs and MII in and out-patients of UITH. Serological test was done using venereal disease research laboratory (VDRL) and the Treponema Pallidum Haemagglutination (TPHA) kit. RESULTS: Of the 700 subjects, 324 (92.6%) MII, and 349 (99.7%) VBDs were <55 years; 71 (21.4%) MII were Civil Servants compared with 96 (27.4%) VBDs. Significantly more VBDs had higher education than MII (185 or 52.9%, and 140 or 40% respectively). Christians constituted the majority (176 or 50.3%) among MII, and Muslims (210 or 60%) among VBDs. Significantly more married VBDs (204/206 or 99.0%) live with spouses; more VBDs consumed alcohol (37 or 10.6%), smoked (19 or 5.4%), and engaged in extramarital sex (105 or 30.0%). Significantly more MII had blood transfusion (40 or 11.4); engaged in sex trade (12 or 3.4%); and more syphilis prevalence (5.4%). In addition, more syphilitic MII smoked (18 or 94.7%); and all syphilitic MII had psychotic disorders. CONCLUSION: The prevalence of syphilis in MII is significantly higher than among VBDs. Routine screening of MII is advocated to stem this problem.

The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University.

OBJECTIVES: This study was prompted by the heightened concerns about the stress inherent in medical education evident from the incessant requests for suspension of studies due to psychological problems. The objectives of the study were to: (i) survey the students for possible psychological problems at admission, and follow them up till exit for possible changes in morbidity, and (ii) ascertain possible risk factors, and coping strategies. METHOD: This is a preliminary 2-stage cross-sectional report, which is part of a longitudinal survey. It involves first year medical students of the College of Health Sciences of University of Ilorin between March and April, 2011. Questionnaires used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslach's burnout inventory (MBI), and Brief COPE. Data were analysed using SPSS version 15 at 5% significance level. Chi-square, frequency distributions, Pearson's correlation, Odd ratios, and Confidence Intervals were calculated to determine the levels of risk. RESULTS: 79 students returned completed questionnaires. 12 (15.2%) were ghq-12 cases (i.e., scored ≥ 3). Students who had morbidity were 9 times at risk of being stressed consequent upon 'competing with their peers' and 4 times at risk due to 'inadequate learning materials'. Morbidity was significantly more likely to engender use of 'religion', 4 times less likely to engender use of 'positive reframing' with a trend in the use of 'self blame' as coping strategies. CONCLUSION: Aside from psychosocial/personal issues in this cohort, academic demand was an additional source of psychological problems thereby causing those who had morbidity to utilize 'religion' and 'positive reframing' to cope. There is therefore an apparent need to incorporate the principle of mental health promotion in medical education.

PSYCHIATRIC MORBIDITY IN A NIGERIAN NEUROLOGY CLINIC.

OBJECTIVE: The objective of the study was to determine the prevalence and nature of psychiatric morbidity among patients attending a neurology outpatient clinic. DESIGN: A two-stage screening procedure with General Health Questionnaire (GHQ-12) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychological disorders over a one year period. Psychiatric diagnosis was based on ICD-10 criteria. SETTING: University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria SUBJECTS: Two hundred and thirty-five (235) patients aged 18 years and above attending the neurology outpatient clinic. RESULTS: Overall prevalence of psychiatric morbidity was 26.0% (61/235). The most frequent diagnoses were depression (14.9%), generalised anxiety disorder (5.5%), dementia (2.6%) and substance use disorder (1.3%). Significantly more patients with stroke had psychiatric morbidity. CONCLUSION: The study supports previous reports that psychiatric disorders are quite common among patients with neurological disorders. Efforts should, therefore, be directed at identifying and treating neurological patients with psychiatric morbidity since this will ensure improved outcome. In this regard, mental health professionals would need to provide liaison services for the neurologists and train them in the use of simple screening instruments for detecting associated psychiatric disorders with appropriate referral where necessary.

Prevalence of psychiatric morbidity among inmates of a borstal institution in Nigeria.

Studies have reported increased psychiatric morbidity among young detainees, with as many as three-quarters reported to have one or more psychiatric disorders. Despite this, however, there is a dearth of published work among young inmates of prisons, remand homes or borstal institutions in Nigeria. The aim of this study was to assess possible psychiatric morbidity among young inmates of a borstal institution in Nigeria and to determine the factors that may be associated with this morbidity. Fifty-three inmates of one of the two existing borstal institution in Nigeria were assessed for psychiatric morbidity using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 scores were compared with the socio-demographic factors of the respondents. Twenty-eight (52.8%) of the inmates were over 18 years old, 35.8% were in the middle position within the family, 62.3% were of Christian faith, and 64.2% had their parents still living together. Seventeen (32.1%) of the inmates were from Hausa ethnic extraction, 58.5% stayed for more than 6 months at the borstal institution, and 81.1% were brought to the institution by their parents. The mean age of the inmates was 17.3 years (range, 14-23 years) and 26 (49.1%) of them were GHQ-positive. There was no statistically significant difference between the mean age of GHQ-positive and GHQ-negative inmates (F=1.73, p=0.19), and none of the socio-demographic variables were significantly associated with psychiatric morbidity (i.e. GHQ-12 positivity). The study observed a high prevalence of undetected psychiatric morbidity among inmates at the borstal institution. Efforts should be intensified by the authority responsible for managing the Nigerian prison services (including the borstal institutions) to improve mental health services.

Predictors of psychiatric readmissions to the psychiatric unit of a tertiary health facility in a Nigerian city - a 5-year study.

OBJECTIVE: Little is known about predictors of readmission of psychiatric patients in the study environment. Knowledge of this, we believe could aid effective management of psychiatric patients, as well as judicious and equitable utilization of the limited mental health facilities in the North-central zone. The aim was to identify factors that may be predictive of readmissions to an in-patient psychiatric facility of a Nigerian University Teaching Hospital. METHOD: A retrospective record review of all admissions and discharges to/from the psychiatric inpatient ward of University of Ilorin Teaching Hospital, (UITH) between May 2000 and April 2005. Patients and clinical characteristics were recorded and all the data were characterized according to age, gender, marital status, occupational status, length of stay on admission, number of admissions, and medication compliance. Data were analyzed with SPSS version 11 to derive the chi square figures, Pearson's correlation, and logistic regression. The level of statistical significance was set at 5%. RESULTS: Within the study period, 41.4% of cases were readmissions. Young age, longer length of stay, multiple admissions and the diagnosis of schizophrenia were predictive of readmission while medication non-compliance was not predictive. CONCLUSION: Provision of psycho-education to both the patients and their families, identification of early symptoms of relapse, application of immediate and appropriate measures, and adequate record-keeping by health institutions are advocated.

Consultation-liaison psychiatry: the past and the present.

Consultation-liaison (C-L) psychiatry a subspecialty in psychiatry is referred to as the guardian of the psychological and holistic approach to patient. It has been undergoing rapid changes especially in the developed countries but its practice is strongly affected by stigma and negative attitude by professional colleagues. In this review, it is recommended that C-L psychiatry must not be restricted to conspicuous acute psychiatric disorders alone but must have impact across the whole of medical care. C-L psychiatrists ever than before must not only concentrate on managing psychotic patients but must strive to maintain intellectual and clinical leadership for the psychological system in its entirety. There is yet more to be done in the area of research and campaign against stigmatization.

A prospective analysis of in-patient consultation-liaison psychiatry in a Nigerian teaching hospital.

OBJECTIVES: To determine the pattern of psychiatric referrals over a six-month period categorise the psychiatric referrals into clinical syndromes and describe the nature of psychiatric intervention and outcome of such intervention on discharge and within the first three months after discharge. DESIGN: A descriptive prospective study. SETTING: University of Ilorin Teaching Hospital (UITH), Ilorin Nigeria. SUBJECTS: Forty seven inpatients (26 females and 21 males) referred to the psychiatric department from other specialist units of the hospital between May and October 2001. RESULTS: The mean (+/-SD) of patients was 33.9+/-18 years. The highest rate of referral came from the internal medicine department. The most common psychiatric disorders referred were acute organic brain syndrome (32%) and neurological disorders (15%). Psychiatric interventions included medication in about two-thirds of the patients and counselling in about a quarter. Half of the discharged patients out rightly defaulted on their first outpatient clinic department appointment. CONCLUSION: The study indicate the need for greater inter-departmental liaison learning and training activities, the need to emphasize training in organic psychiatry, as well as the need to establish community-based outreach services as a means of ensuring continuity of care for discharged patients.